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AFOR OFFICE USE: APPLICATION' FOR SANITATION PERMIT �J Permit No. ------------- -------------------------- ---------------- (Complete in Triplicate) -------------------------------------- Date Issued This Permit Expires I Year From Date Issued _ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: -----------CENSUS TRACT ------ _ .,JOB ADDRESS/LOCATION .- �'; 5------_" _ - ' k -----------Phone -!_ --.- Owner's Name -� I Address P{pf--170-30K-��---_--_7;-+ �--------• - --------- -------- --------------------- city CJ�J ------------------ ---- ----------- ------ --------------- tf! e License Phone -------- - --------- Contractor's Name --0, F Installation will serve: Residence [V Apartment House❑ Commercial :[Trailer Court '❑ Motel ❑Other -------------------------------------------- N.umber -------------------------------------Number of living units:---- Number of bedrooms -----9---Garbage Grinder .___.______ Lot Size ---------•---- 4 Private$� Water Supply: Public System and name -----------.------ ------- -------------------------------------------------- Cllaa Character of soil to a depth of 3 feet: Sand+�, Silt❑ Clay E] Peat[I Sandy Loam ❑ y Loam:❑ � Hardpan ❑ Adobe Fill Material --------- If yes,type _- (Plot plan, showing size of lot, location of system in relation' to wells, buildings, etc. must be placed on reverse side.} N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, PACKAGE TREATMENT 11 SEPTIC TANK [ ] Size- ---------------------- capacity -------------------- liquid Depth ------------------ --..__. Ca aci -- Type ------------------ - Material------------- -------- No. Compartments ------ -------•------- Distance to nearest: Well --------- -----=Foundation ----------- ---------- Prop. Line ---------------------- --- Len th each line------- ---------- ------- g � L#:ACHING LINE [ ] No. of Lines -- g otal Length ---------------------------- Depth __________________________ . ------------------ -- De th Filter Mat riai -------------------------------------------- a t 'D' Box -------- --- Type Filter Material ___--_________- p _ ____._ Foundation Property Line Distance to nearest: Wel! -------------- - - --------- ---- SEEPAGE PIT Depth -- Diameter ------- ------- Number -------- -------------- Rock Filled Yes ❑ No C] Water Table DepthRock Size -______--- -------------------- ------------------------- -------- Distance to nearest: Well ----------------- ------------------- Foundation ------ ---------- Prop. Line _-----------.--------- ( REPAIR/ADDITION(Prev. Sanitation Permit F# -------- ------------- Date'------------------- --------------1 Septic Tank (Specify Requirements) ------------------- -------------------------------- Disposal Field (Specify Requirements), ----------------------------------- ---------- ----- - - -------- ---;------ r a ------------------------- __e /rte .�� e o /� �f/rte- - -------------- _ - - -- - �-�-----------�------- --- -- --- - - _ _ (Draw existing and required addition on reverse side} pared this application and that the work will be done in accordance with San Joaquin I hereby certify that I have pre County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or 1'icen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Y (-lf o-t-her ---- ----------------------- Owner Title --- -------------------------------- -------=--------------- BY than owner} FOR .DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY i -ii DATE - f� �- 1 tMPERMIT ISSUED ------------------- ------------------------------------ DATE .------------------------------------------ BUILDING�.- ADDITIONAL COMMENTS --------- ------------ ------------ ------------- ------------- --- -•-------------= ----- ------------------------ - 1 - --------------------------------- A ----------�------ - r ------ Date ` Final -- SAN JOAQUIN LOCAL HEALTH DISTRICT , E. H. 9 1-'68 Rev. 5M